The event’s organizers, members of Citizens for Sauk County Health Care Center, sought to dial up community support and pressure regulators to block the nursing home’s sale.

Khan told the audience that the prospective sale of their county home represents a troubling trend. “We’ve been watching with some alarm as more and more mergers and consolidation mean that fewer and fewer players are coming to control important parts of the health care system.”

The Sauk County Health Care Center is an 82-bed skilled nursing facility in Reedsburg with a three-star rating from the Centers for Medicare and Medicaid Services (CMS). In September, the Sauk County Board of Supervisors voted to sell the nonprofit facility to for-profit Aria Healthcare of Milwaukee for $5.1 million.

Citizens for Sauk County Health Care Center maintain that the price offered for the facility is too low, the private operator would deny service to low income residents and the quality of care at the facility would suffer. The sale would also represent a dramatic break from the past—Sauk County has operated some form of care facility since 1871 (the county’s current nursing home was built in 2008). Proponents of the sale, including the board’s chair Tim McCumber, have offered shifting reasons for the sale: that the home has been a “lag on the tax levy,” that it is not able to break even or that there is no state mandate that Wisconsin counties provide care for their seniors.

Sauk County is not alone. A debate with strikingly similar contours is raging across rural Wisconsin. In the badger state, 21 counties currently support publicly-owned nursing homes. Nationally there are 422 county-owned and operated nursing homes in 32 states. These establishments are generally highly rated, affordable, beloved by their communities and some have a history of service stretching back more than a century.

Yet in recent years these venerable institutions, and the underlying belief that they constitute a public good, have been under attack. A new more radical breed of conservative, emboldened by the zeitgeist of the Trump era, has taken electoral control over many ostensibly non-partisan county and municipal elected bodies. These leaders claim it is not their county’s responsibility to provide senior care and it is no longer viable for taxpayers to fund these nursing homes.

People in these counties recognize the need for affordable quality senior care, particularly in underserved rural areas with aging populations. They are also increasingly aware of how acquisition of public nursing homes by private equity has reduced the quality of care in what were once highly rated nursing facilities that provided a lifeline to poorer aging or disabled citizens. In response, citizen groups have sprung up in four Wisconsin counties to prevent their county nursing homes from becoming relics of the past.

Lincoln County: Rule by decree, rather than consent

The ongoing fight in Lincoln County over the fate of Pine Crest Nursing Home is echoed in Sauk, Portage and St. Croix Counties.

In February, I reported on how the grassroots organization People for Pine Crest was working to stop the sale of Pine Crest, a five-star, 120-bed skilled nursing facility owned by the county and operated by the local organization North Central Health Care.

In April’s local elections, Don Friske, a former GOP state senator and then-chairman of the county’s board of supervisors who led efforts to sell the home, lost his county board seat to challenger Christine Vorpagel, who supports keeping Pine Crest public. After the election, Don Dunphy, a former district attorney and another recently elected member of the board, filed a lawsuit challenging the sale. While Dunphy’s suit may have only slowed the sale for the time being, it also exposed larger issues with how the county was going about privatization.

Elizabeth McCrank, a county board member aligned with the People for Pine Crest, said that the procedural errors and cavalier actions on the part of the current board, a majority of whom are MAGA-affiliated Republicans and support the sale, were opening it up to further lawsuits that would cost the county money. She says the issues raised in Dunphy’s suit need to be dealt with prior to any sale. “If the idea is to save taxpayers money, this board is not doing a good job of that.”

McCrank tells Barn Raiser the board has resisted exploring novel methods of increasing revenue from Pine Crest, like using the facility to provide child daycare services. “That’s funny, they’re doing it in La Crosse,” she says. “Maybe they’re on a different planet than we are.” La Crosse County’s Hillview Healthcare Center is planning to offer child daycare services to county residents in its new Intergenerational Day Programming Center.

Both Dunphy and McCrank criticized the pro-sale majority on the board for refusing to allow Lincoln County voters to decide in a referendum during the November election whether the county home should be privatized. This refusal speaks to both a lack of faith that their constituents would support the sale and a preference for rule by decree rather than consent—a scenario that is playing out in other counties in the state where a sale of the county home is proposed.

Sauk County: ‘Every number they provide to the public is an absolute lie’

Tom Kriegl, a retired agricultural economist who served for two decades on the Sauk County Board of Supervisors, tells Barn Raiser that the financial data provided by the current board to justify the sale does not hold water. “I’ve taken the numbers from the official Sauk County budget books and other financial reports to demonstrate that practically every number they provide to the public is an absolute lie,” he says. At the meeting with the Federal Trade Commission Chair Khan, he held up a folder containing his documentaion, and offered to show it to anyone. “So far no one has beeen willing to compare my documentation with the false claims of those who want to sell the nursing home,” he says.

According to Kriegl, the current board’s claims of fiscal responsibility are at odds with how it has historically spent public funds. The board recently spent $50 million on a highway department facility. What’s more, the county is currently spending about $8 million a year of its $150 million budget to operate the county jail. To the current board, spending money wisely is spending things in the way that they prefer spending them,” Kriegl says, “not necessarily based on any measure of using money wisely. Recent significant permanent increases in Medicare/Medicaid reimbursement rates means that with the same resident population mix, the nursing home could generate at least $1 million more income than operating expense in 2024 without property tax dollars. ”

Judy Brey, a retired public school speech and language therapist, fighting the sale of Sauk County’s nursing home, says that the board had been opaque about its process, holding closed sessions and failing to inform the public about prospective buyers. Brey says the board held no public hearings on the sale and that the decision to privatize was made by the board’s properties committee without input from the finance committee or the board of trustees for the county home.

Citizens for Sauk County Health Care Center are concerned that the prospective buyer, Aria Healthcare, has a track record for low quality of care in its 16 Midwest facilities, four of which are in Wisconsin, all but one of the companies nursing homes have a one- or two-star rating from CMS. Of the 16 facilities operated by Aria, 12 have been put on a watch list by the Nursing Homes Abuse Advocates for instances of harm to residents and staffing problems.

Kriegl says this record makes Aria an unsuitable buyer and conflicts with the board’s conditions for the sale passed in December 2023 that the company proposing to buy the facility have a history of five-star ratings.

Citizens for Sauk County Health Care Center is lobbying the Wisconsin Department of Health Services, which would have to approve the transfer of the beds to the prospective buyer, to stop the sale. The current facility was built in 2009 for $15 million and the board is proposing to sell it for $5.1 million, says Brey, adding that the citizens group is considering suing the board for fiscal malfeasance and has hired an attorney.

“There has been a total lack of transparency,” Brey says. “There was never a single public hearing. There was no referendum. They never had it appraised when they put it up for bids. There was nothing. It’s totally ideological.”

St. Croix County: ‘We take care of our own’

Meanwhile, on the western edge of Wisconsin attempts to privatize the St. Croix County Health Care Campus in New Richmond have been met with intense resistance. Earlier this summer, conservative members of the county board began investigating the possibility of selling the four-star 50-bed nursing home, triggering public outcry that shut down the privatization effort and paved the way for the creation of a new dementia unit. This new unit, along with increased Medicaid reimbursement rates enacted in 2023 by the state, is projected to help maintain the facility as not only stable but even profitable moving forward.

In the last 20 years, attempts to privatize the St. Croix county home have been shot down twice, first in 2006 and later in 2012 with a county referendum where two thirds of voters supported using tax revenues to sustain the facility. Despite the history of intense support for the facility, the board once again questioned the need for keeping it public.

The reemergence of the idea of of a sale galvanized locals to mobilize and stop the privatization. And like those fighting to save county nursing homes in Sauk, Portage and Lincoln Counties, they established a Facebook group, Keep St. Croix County’s Nursing Home. One of the St. Croix citizens who organized the resistance, Peg Audley, says a small but ideologically motivated group on the current board have carefully selected board committee leaders who align with their goals to sell the county nursing home. Like in other counties, these conservatives say there is no state mandate that counties like theirs must provide nursing care.

For Audley, that argument lacks substance. “[The Health Care Campus] has been here for over a hundred years. This is what we do. We take care of our own.”

Audley says that access to the facility was something that low income people living in the county, especially farmers, counted on. Support for keeping public ownership of the facility is something that transcends politics, she says, with signatories of a petition to halt the sale coming from all areas of the county. “This was not a partisan issue.”

Kim Dupre, who worked for St. Croix County for almost 20 years and opposes the sale, says that the county has a very low ratio of skilled nursing beds relative to its population. Without the publicly-owned facility many elderly or sick citizens on Medicaid would have no other option. “If the private [companies] aren’t willing or able to take on the Medicaid population, who is? And if we can’t have government do it, are you having people actually homeless in the streets or are you having family members leave the workforce to care for somebody at home?”

According to Chris Babbitt, a former member of the St. Croix county board who opposes the sale, one of the chief concerns of the current board is to cut spending wherever possible without consideration for public input. Babbitt points to the St Croix University of Wisconsin-Madison County Extension Office as a prime example. The office was a minor budgetary item and was beloved by the local community but was cut by the board based on their ideological opposition to unmandated public services.

Public outcry has been strong enough to stop discussion of selling the St. Croix County Health Care Campus. But the citizens who organized against it say they will remain vigilant until the budget for next year is passed.

Portage County: ‘Not a penny to take care of our poor, sick elderly’

In Portage County concerned locals face an uphill battle to save their Portage County Health Care Center, a five-star 48-bed facility in Stevens Point. Despite Portage County’s tradition of public care facilities stretching back over a century—its future is deeply uncertain.

Nancy Roppe, a retired IT professional who with her husband Joe helps run the Facebook group Save the Portage County Health Care Center, says the genesis of that uncertainty lies with conservative county board members who have been elected in recent years. Like in other counties, this conservative majority argues that because nursing home care is not mandated by the state the county is under no obligation to provide it, that the cost of running the home exceeds the benefit, and that taxpayers should not be footing the bill for nursing care that can be provided by a free market.

According to Roppe, two binding ballot referenda, one in 2018 and the other in 2022, confirmed public support for the construction of a new facility, with the vote in 2022 being 59% in favor of building a new county nursing home and 41% opposed. But she says the board has delayed moving forward with plans to build a new facility, and have refused to approve any referendums that could jeopardize their privatization agenda.

“It was almost to the point where we were going to have shovels in the ground and this MAGA County Executive John Pavelski and the MAGA County Board Chair Al Haga insisted that we put ‘a pause’ on the project,” Roppe says. “For months and months and months, they would have things put on the board agenda that were a complete waste of time.”

By stalling long enough, pro-sale members of the board were able to shut down plans for a new facility, leaving the Portage County Health Care Center in a precarious position. The current facility, constructed in 1931, struggles to meet state requirements for ventilation, despite maintaining a high rating.

Meanwhile, members of the board who are bent on privatizing the county’s nursing home, have plans to build a “Justice Center:” a large new county jail and law enforcement facility on 42 acres of land in the town of Plover. This Orwellian sounding institution would cost Portage County taxpayers an estimated $180 to $400 million. By contrast, estimates for a new facility for the nursing home totaled around $25 million.

“So they’re more than willing to spend $400 million building this glorious monument to lawbreakers, but not a penny to take care of our poor, sick elderly,” says Roppe. “It’s disgraceful. It’s immoral. But they don’t care.”

While local activists remain dedicated to trying to preserve the home, the situation is grim. Roppe says that rumor has it that County Executive Pavelski has four buyers lined up. Should the sale go through, lower income members of the community reliant on Medicaid would be at the mercy of a private nursing home industry that is free to deny them care.

‘You don’t know if you are voting for a MAGA or not’

Thanks to recent increases in reimbursements from Medicare and Medicaid, many of Wisconsin’s county-owned nursing homes, which in general accept more Medicaid patients than other nursing homes, are beginning to operate more profitably, calling into question arguments for the financial necessity of their sale.

George Goehl, a community organizer who is the former executive director of People’s Action, a national advocacy organization composed of 40 nonprofits in 30 states, is helping support local efforts to save Wisconsin’s county nursing homes. Goehl thinks the concept of county-owned nursing homes deserves a renaissance. High quality county care facilities should be viewed, he says, “not as relics of the past but as a model for the future.”

Goehl, as host of To See Each Other podcast, has been covering this “threat of private money coming into change public institutions.” In the introduction to the series on the battles to save Wisconsin’s county owned nursing homes, Goehl says, “Folks are angry about being treated like they’re expendable and they are deeply afraid about what this means for the future. It’s a heart pounding, roller coaster of a fight.”

In Portage County, as in Sauk, St. Croix and Lincoln County, the fight over the future of the county nursing home is now being waged at the ballot box. A September 2024 survey by Hart Research found that 65% of older voters in rural and small town communities—including 89% of Democrats, 65% of swing voters, 64% of independents and 43% of Republicans—opposed “private companies buying public county-owned nursing homes here in Wisconsin.”

According to Portage County organizer Roppe, their problems stem from the fact that far-right Republicans have managed, by organizing stealth campaigns, to gain control the board of supervisors in blue Portage County. She says, “They target these nonpartisan races where you don’t know if you are voting for a MAGA or not,” she says.

In last April’s local elections, Roppe says the top two issues were the future of the Portage County Health Care Center and the cost of the proposed Justice Center. According to Roppe, the new 26-member board of supervisors now includes 15 board members who support the sale of the county home and 11 board members who are against it. “But it was worse before the April election,” she says, “with 20 for and 6 against.”

“Al Haga, the county board chair who had been on the board for 16 years, was among those who got bounced,” she says. “MAGAs controlled the board before and they still do, but to a lesser extent. We’re hopeful we can flip more seats in 2026.”

Henry Bleifuss

Henry Bleifuss is a central Wisconsin local from the Wausau area. He attended college at UW Stevens Point where he studied history. He can regularly be found wandering the forests of upper Wisconsin with a questionable sense of direction.